Provider Demographics
NPI:1295326635
Name:STEWART, AMBER DAWN
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0835
Mailing Address - Country:US
Mailing Address - Phone:304-294-2025
Mailing Address - Fax:304-294-2045
Practice Address - Street 1:3776 MOUNTAINEER HIGHWAY
Practice Address - Street 2:
Practice Address - City:MABEN
Practice Address - State:WV
Practice Address - Zip Code:25870
Practice Address - Country:US
Practice Address - Phone:304-294-5610
Practice Address - Fax:304-294-2045
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1932326121Medicaid